District Court Denver Probate Court __________________________________ County, Colorado Court Address: In the Interests of: COURT USE ONLY Case Number: Protected Person Division: Courtroom: CERTIFICATE OF ANCILLARY FILING - CONSERVATORSHIP The following listed documents regarding _______________________________, as the foreign conservator, have been filed with this Court: The foreign conservator’s sworn statement stating that no administration, application, or petition for administration is pending in Colorado. Certified, exemplified, or authenticated copies of the foreign court’s order appointing the foreign conservator. Certified, exemplified, or authenticated copies of the foreign court’s letters or other documents evidencing or affecting the foreign conservator’s authority to act. Certified, exemplified, or authenticated copies of any bond of the foreign conservator. Other: ______________________________________________________________________________ Date: ________________________________ ___________________________________________ (Deputy) Clerk or Registrar of Court [COURT SEAL] JDF 892 11/07 CERTIFICATE OF ANCILLARY FILING – CONSERVATORSHIP American LegalNet, Inc. www.FormsWorkflow.com